BEMS in Healthcare: Improving hospital performance

Healthcare buildings are among the most complex and demanding environments in the built environment. Unlike most commercial buildings, hospitals operate continuously, accommodate highly vulnerable patients and depend on tightly controlled indoor conditions to support patient care, staff wellbeing and operational performance.

Against a backdrop of rising energy costs, ageing infrastructure, increasing sustainability requirements and growing overheating risks, healthcare estates are under pressure to deliver more with less. In that context, the role of Building Energy Management Systems (BEMS) in healthcare is becoming increasingly important.

According to Ron Purcell, Vice President of the Building Controls Industry Association (BCIA) and Product Manager at Siemens, healthcare organisations are reaching a point where reactive building management is no longer enough.

"Healthcare estates need greater visibility, control and optimisation across their buildings. The challenge is not simply reducing energy consumption. It is about maintaining safe, comfortable and resilient environments for patients and staff while ensuring buildings can operate efficiently and reliably around the clock."

Why healthcare environments demand smarter control

Hospitals present unique operational challenges. Different spaces often require different environmental conditions, from wards and operating theatres to laboratories, pharmacies and administrative offices. Occupancy levels fluctuate, critical equipment generates significant heat loads and ventilation systems must support infection control requirements while maintaining comfort and indoor air quality.

Balancing these competing demands is increasingly difficult as the healthcare estate ages and climate pressures intensify, particularly where compliance with healthcare-specific guidance such as HTM 03-01 (ventilation) and HTM 00 (risk management) is required to maintain patient safety and clinical outcomes.

The BCIA's white paper, Comfort, Efficiency and Health: The Untapped Potential of Building Energy Management Systems, highlights the scale of the challenge. According to NHS estate data cited in the BCIA white paper, around 90% of NHS buildings are considered at risk of overheating, while overheating incidents in occupied wards and clinical areas nearly doubled from 2,980 incidents in 2016-17 to 5,554 incidents in 2021-22.

The consequences extend beyond comfort. Nearly one in five hospitals surveyed reported that the 2022 heatwave resulted in the cancellation of elective surgeries, demonstrating how building performance can directly affect healthcare delivery.

Using BEMS to address overheating and resilience

BEMS provide healthcare estates teams with the ability to monitor, control and optimise building systems in real time. By integrating HVAC, ventilation, lighting and energy systems through a central platform, buildings can respond dynamically to changing conditions rather than relying on fixed operating schedules.

This enables facilities teams to identify overheating risks earlier against recognised criteria such as CIBSE TM52/TM59, optimise ventilation performance in line with required air change rates (ACH), and maintain stable pressure regimes (positive/negative) in critical environments such as operating theatres and isolation rooms.

Advanced controls can also help manage the growing tension between maintaining comfortable indoor environments and reducing energy consumption. Rather than increasing cooling demand indiscriminately, BEMS allow systems to respond intelligently based on occupancy, temperature, air quality and operational requirements.

For hospitals operating 24 hours a day, this level of optimisation can deliver significant operational benefits.

Improving energy and carbon performance

While hospitals have less flexibility to reduce energy demand than many commercial buildings due to their clinical requirements and continuous operation, building controls can still make a meaningful contribution.

The BCIA white paper found that upgrading a typical medium-sized acute hospital from a standard Class C system to an advanced Class A BEMS (as defined in EN ISO 52120 for building automation and control system efficiency) could reduce energy consumption by approximately 1.8 GWh over a ten-year period, equivalent to nearly 180 MWh per year. The analysis also identified carbon savings of around 290 tonnes of CO₂e over the same period, representing an estimated 12% reduction in hospital carbon emissions depending on energy mix and site conditions.

These savings are particularly important as the NHS works towards its net zero commitments while continuing to manage significant financial pressures.

Importantly, building controls can help healthcare organisations improve performance without necessarily requiring major infrastructure replacement programmes. By optimising existing systems, estates teams can often achieve measurable improvements through better operational control and visibility.

Supporting maintenance and operational resilience

Healthcare buildings depend on the reliable operation of critical systems. Unplanned failures can affect comfort, disrupt services and increase operational costs.

One of the less visible but equally important benefits of modern BEMS is the ability to support predictive and proactive maintenance. By continuously monitoring system performance and energy use, building operators can identify abnormal behaviour, equipment faults and emerging issues before they become significant problems.

For example, in a live hospital environment, a BEMS may detect that a heating control valve is not fully closing, leading to simultaneous heating and cooling within an air handling unit (AHU). This common but often hidden fault can result in excess energy use, unstable temperatures and increased plant wear. Through continuous monitoring and alarm analytics, the issue can be identified and resolved before it impacts patient comfort or critical clinical spaces.

This not only improves reliability but can also help extend equipment life and reduce maintenance costs.

As Ron explains: "Modern BEMS provide far more than energy management. They give healthcare estates teams the information they need to make informed operational decisions, improve resilience and ensure buildings continue to support the people who depend on them."

Preparing healthcare estates for the future

The pressures facing healthcare buildings are unlikely to diminish. Climate change, rising temperatures, increasing energy costs and growing demands on healthcare services will continue to place greater emphasis on building performance.

For many NHS trusts and healthcare providers, improving how existing buildings operate - while maintaining strict compliance with healthcare engineering standards and ensuring patient safety - may be one of the most practical and cost-effective ways to enhance resilience, support sustainability goals and deliver clinically appropriate environments.

BEMS provide a proven route to achieving this. By helping hospitals respond more intelligently to changing conditions, optimise energy use and maintain comfortable indoor environments, advanced building controls can play an increasingly important role in supporting the future performance of the healthcare estate.

For organisations looking to unlock these benefits, guidance from industry bodies such as the BCIA can support best practice in specifying, implementing and optimising high-performance BEMS aligned with healthcare requirements.